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J Aging Stud. 2015 Dec;35:201-10. doi: 10.1016/j.jaging.2015.08.011. Epub 2015 Nov 9.

The need for a social revolution in residential care.

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Graduate Programs in Rehabilitation Sciences, Faculty of Graduate Studies, University of British Columbia, T325-2211 Wesbrook Mall, Vancouver V6T 2B5, British Columbia, Canada. Electronic address:
Department of Occupational Science and Occupational Therapy, University of British Columbia, 2211 Wesbrook Mall, Vancouver, BC V6T 2B5; International Collaboration on Repair Discoveries, 818 W 10th Ave., Vancouver, BC V5Z 1M9; G.F. Strong Rehabilitation Research Program, 4255 Laurel St., Vancouver, BC V5Z 2G9, Canada. Electronic address:
LeadingAge, 2519 Connecticut Avenue NW, Washington, DC 20015, United States. Electronic address:
Department of Occupational Science & Occupational Therapy, Faculty of Medicine, University of British Columbia ,T325-2211 Wesbrook Mall, Vancouver, B.C. V6T 2B5, Canada. Electronic address:
School of Social Work and Social Policy, Trinity College Dublin, Dublin 2, Ireland. Electronic address:
Yale University, School of Medicine, Department of Internal Medicine, 333 Cedar St, New Haven, CT 06510, United States. Electronic address:


Loneliness and depression are serious mental health concerns across the spectrum of residential care, from nursing homes to assisted and retirement living. Psychosocial care provided to residents to address these concerns is typically based on a long-standing tradition of 'light' social events, such as games, trips, and social gatherings, planned and implemented by staff. Although these activities provide enjoyment for some, loneliness and depression persist and the lack of resident input perpetuates the stereotype of residents as passive recipients of care. Residents continue to report lack of meaning in their lives, limited opportunities for contribution and frustration with paternalistic communication with staff. Those living with dementia face additional discrimination resulting in a range of unmet needs including lack of autonomy and belonging-both of which are linked with interpersonal violence. Research suggests, however, that programs fostering engagement and peer support provide opportunities for residents to be socially productive and to develop a valued social identity. The purpose of this paper is to offer a re-conceptualization of current practices. We argue that residents represent a largely untapped resource in our attempts to advance the quality of psychosocial care. We propose overturning practices that focus on entertainment and distraction by introducing a new approach that centers on resident contributions and peer support. We offer a model-Resident Engagement and Peer Support (REAP)-for designing interventions that advance residents' social identity, enhance reciprocal relationships and increase social productivity. This model has the potential to revolutionize current psychosocial practice by moving from resident care to resident engagement.


Depression; Loneliness; Peer support; Psychosocial care; Recreation therapy; Social identity

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